RAGHAVENDRA G MIRMIRA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****33

License Status

ACTIVE

Business

Title

First Name

RAGHAVENDRA

Middle

Last Name

MIRMIRA

Business Name

RAGHAVENDRA G MIRMIRA MD

Original Issue Date

08/28/2019

Effective Date

04/07/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60613

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2023